双源心脏计算机断层扫描血管造影在左心耳封堵中的应用

Application of Dual-Source Cardiac Computed Tomography Angiography in Left Atrial Appendage Occlusion

目的探讨双源心脏计算机断层扫描血管造影(dual-source cardiac computed tomography angiography,DCTA)在左心耳封堵术中的指导意义及术后随访中对残余漏、器械相关血栓的检出效果。方法收集2017年3月至2020年6月在江苏省泰州市人民医院行左心耳封堵术的心房颤动(房颤)患者216例,其中术前行经食管超声心动图(transesophageal echocardiography,TEE)组78例患者,男45例,年龄为(65.4±4.2)岁;女33例,年龄为(67.1±5.3)岁。术前予DCTA检查行左心耳三维重建(CTA组)138例,男87例,年龄为(73.3±5.1)岁;女51例,年龄为(74.0±4.8)岁。统计两组患者术前左心耳血栓的检出率、手术时间及数字减影血管造影(digital subtraction angiography,DSA)射线量,在正规抗凝3、6个月后根据患者愿意分别予DCTA和(或)TEE检查统计残余漏、器械相关血栓情况,其中同时行TEE和DCTA检查的共43例。结果术前DCTA和TEE对左心耳血栓检出率比较,差异无统计学意义(P>0.05);术中DCTA组有更短的手术时间[(40.4±10.8)min vs.(52.3±18.7)min,P<0.05]和更少DSA射线量[(258.2±28.6)mgy vs.(360.5±20.3)mgy,P<0.05]。术后两组患者残余漏发现率比较,差异无统计学意义(85%vs.78%,P>0.05)。术后两组患者器械相关血栓(DRT)发现率比较,差异无统计学意义(P>0.05);但大部分患者(197∶43)术后愿意接受DCTA随访。结论术前DCTA检查不但可用来排除左心耳血栓并对左心耳封堵手术有很好的指导作用,减少了手术时间及DSA射线量,术后对残余漏及DRT的发现率不劣于TEE,且更易为患者接受,DCTA不失作为不愿接受TEE检查者的替代方法。

Objectives To explore the guiding significance of dual-source cardiac computed tomography angiography(DCTA)in left atrial appendage occlusion and the detection effect of residual leakage and device-related thrombus in the postoperative follow-up.Methods It was a collection of 216 patients with atrial fibrillation who underwent left atrial appendage occlusion in the People′s Hospital of Taizhou City from March 2017 to June 2020.The 78 patients underwent preoperative transesophageal echocardiography(TEE)were in TEE group,45 cases of them were males,average age was(65.4±4.2)years;33 cases of them were female,average age was(67.1±5.3)years.The 138 cases received DCTA examina⁃tion for left atrial appendage three-dimensional reconstruction before operation were in DCTA group,87 cases of which were male,average age was(73.3±5.1)years;51 cases of which were female,average age was(74.0±4.8)years.Operation duration,detection rate of left atrial appendage thrombosis and digital subtraction angiography(DSA)radiation dose of the two groups were compared.After regular anticoagulation for 3 months and 6 months,according to the patient′s willingness to perform DCTA or(and)TTE examinations to find statistics of the situation of leakage and device-related thrombosis,43 cases among them underwent TEE and DCTA examinations at the same time.Results There was no significant differ⁃ence between the preoperative DCTA and TEE on the left atrial appendage thrombosis detection rate(P>0.05).DCTA group had a shorter surgical time during the operation[(40.4±10.8)min vs.(52.3±18.7)min,P<0.05]and less DSA radiation[(258.2±28.6)mgy vs.(360.5±20.3)mgy,P<0.05]when compared with those of TTE group.There was no significant difference in the detection rate of residual leakage between the two groups after surgery(85%vs.78%,P>0.05).The ability to detect device-related thrombosis was comparable of the two groups(P>0.05),but most patients(197∶43)were willing to receive DCTA follow-up after surgery.Conclusions Preoperative DCTA examination can not only be used to exclude left atrial appendage thrombosis but also has a good guidance on left atrial appendage occlusion surgery.It can reduce the operation time and DSA ray amount and its postoperative detection rates of residual leakage and device-related thrombosis are not inferior to TEE.It is easier to be accepted by patients.DCTA is regarded as an alter⁃native method for those who are unwilling to accept TEE examination.